spinal kinematics in chronic low back pain

Conditions: Chronic Low Back Pain

Summary: chronic low back pain (clbp) is one of the most frequent causes for limitations in daily, leisure and work-related activities. although alterations in spinal motor behavior were consistently reported in clbp patients, it remains unclear how improvements in spinal motor behavior through rehabilitation treatment affect pain and disability. psychological factors, such as pain-related fear, were suggested as a possible main cause of spinal motor behavior in clbp and better understanding their relationships with kinematic and muscle activity alterations is required to enhance care, particularly physiotherapy. therefore, this study will test clbp patients before and after a 3 week rehabilitation program to test the hypotheses that: 1) improvements in spinal motor behavior (kinematics and trunk muscle activity) are associated with decreased pain and disability; 2) decrease in pain-related fear is associated with spinal motor behavior improvements.

the research project is a prospective observational cohort study. clbp patients participating to a 3 weeks' multimodal rehabilitation program will be tested in the motion analysis laboratory before (t1) and after (t2) the program. this program is an intensive 3-weeks multidisciplinary rehabilitation program. patients come daily for individual and group treatments, with a total of 100 hours of intervention during 3 weeks. the program includes physiotherapy treatments, occupational therapy, psychologists encounters and education session. the programs encompasses a multidimensional view of chronic low back pain. therefore, this setting is a unique opportunity to improve our understanding of the role of motor behavior alterations in clbp because it will allow connecting changes in spinal kinematics and muscle activity with changes in pain, disability and pain-related fear. this project has two aims in relation to motor behavior in patients with clbp: the first aim is to analyse the relationship between changes in spinal kinematics and changes in pain and disability during and after a multimodal rehabilitation program. first, changes in spinal kinematics and muscle activity between t1 and t2 will be calculated. the relationship between these changes and changes in pain and disability during the program will be tested. pain and disability will be also measured at 3 months (t3) and one year (t4) after the program, which will allow to further analyze the relationship between spinal motor behavior and pain and disability. the second aim concerns the role of pain-related fear, and its decrease, in spinal motor behavior alterations. consequently, the second aim is to analyse if changes in pain-related fear are associated with changes in spinal kinematics during a multimodal rehabilitation program.

Eligibility criteria:
inclusion criteria: * non-specific low back pain (pain from lower ribs to gluteal folds) for more than 3 months * sufficient french level to understand the instructions for the tests, the information sheet, the consent form and the questionnaires * both male and female adults will be included * age more than 18 years old. exclusion criteria: * pregnancy * skin allergy to tape * body mass index (bmi) above 32 * any sign of specific low back pain such as the presence of infection, rheumatologic or neurological diseases, spinal fractures, any known important spinal deformities, previous back surgery that limits spinal mobility, tumours * high level of pain at the time of experiment that prevents repeated movements (severity and irritability) * other concomitant pain or condition that could compromise the evaluation of spinal kinematics.

Keywords: movement analysis spinal kinematics muscle activity pain-related fear rehabilitation spine